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General NPI Number Information
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NPI Number | 1891448734
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Entity Type | Organization
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Legal Business Name | IDA GORSHTEYN, DDS, MS, INC.
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 2445 CLEMENT ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-1921
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Country | US
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Telephone | 415-668-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 283 PARKER AVE APT C
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-3365
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IDA GORSHTEYN
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Credential | DDS, MS
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Telephone | 408-438-7332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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